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STATE ID NUMBER 00000011279001 <br /> APPLICATION FOR PERMIT TO OPERATE UNDERGROUND STORAGE TANK <br /> (SCj <br /> 01 NEW PERMIT ( ) 05 RENEWED PERMIT ( ) 07 TAMC CLOSED ( ) 09 DELETE FROM FILE (NO FEE) <br /> r_r02 CONDITIONAL PERMIT ( 1 06 AMENDED PERMIT ( ) 08 MINOR CHANGE (NO SURCHARGE) <br /> I OWNER <br /> NAMI(CORPORATION,XNDIVIDUAL OR PUBLIC AGENCY) PUBLIC AGENCY ONLY <br /> CITY Of STOCKTON ( ) <br /> 01 FED ( ) 02 STATE (d 03 LOCAL <br /> STREET ADDRESS CITY TATE 2IP <br /> 425 N. EL DORADO STOCKTON CA %202 <br /> II FACILI/T'Y /- [J <br /> FACILITY NAME L.(. CK111�7�)1'�'e ��P' DIALER/FOREMAN/SUPERVISOR <br /> 512=16 COMPAw.c COMPANY OFFICERS <br /> STREET ADDRESS NEAREST CROSS STREET <br /> 1767 W. HAMMER LANE ALEXANDRIA <br /> CITY COUNTY IIP <br /> STOCKTON SAN JOAQUIN 95209 <br /> MAILING ADDRESS CITY STATE ZIP <br /> 1767 W. HAMMER LANE STOCKTON CA 95209 <br /> PHONE W/AREA CODE TYPE OF BUSINESS <br /> 209-951-7262 f 1 01 GASOLINE STATION (X) 02 OTHER FIRE STATION <br /> NUMBCR OF CONTAINERS RURAL AREAS ONLY : TOWNSHIP RANO! SlCTION <br /> 1 N/A N/A N/A <br /> III 24 HOUR EMERGENCY CONTACT PERSON <br /> DAYS: NAME(LAST NAME FIRST) AND PHONE W/A N EA CODE NIGHTS: ME(LAST NAME FIRST) AND PHONE W/AREA CODE <br /> �Ls �o9 'r6y ybYf� -s cel -Age, <br /> COMPLETE THE FOLLOWING ON A SEPARATE FORM FOR EACH CONTAINER <br /> IV DESCRIPTION <br /> A. (X) 01 TANK ( ) 04 OTHER: CONTAINER NUMBER <br /> B. MANUFACTURER (IF APPROPRIATE): UNKNOWN YEAR MFG: C. YEAR INSTALLED 1974 l ) UNKNOWN <br /> 0. CONTAINER CAPACITY: 550 GALLONS ( ) UNKNOWN E. DOES THE CONTAINER STORE: ( ) 01 WASTE (X) 02 PRODUCT <br /> F. DOES THE CONTAINER STORE MOTOR VEHICLE FUEL OR WASTE OIL ? (X) 01 YES ( ) 02 NO IF YES CHECK APPROPRIATE BOX(ES): <br /> ( ) 01 UNLEADED ( ) 02 REGULAR ( ) 03 PREMIUM (X) 04 DIESEL ( ) 05 WASTE OIL ( ) 06 OTHER <br /> V CONTAINER CONSTRUCTION <br /> A. THICKNESS OF PRIMARY CONTAINMENT: f 1 GAUGE l ) INCHES ( 1 CM (X) UNKNOWN <br /> B. f 1 01 VAULTED (LOCATED IN AN UNDERGROUND VAULT) f ) 02 NON-VAULTED (X) 03 UNKNOWN <br /> C. ( ) 01 DOUBLE WALLED (_%"O SINGLE WALLED ( 1 03 LINED <br /> D. t ) 01 CARBON STEEL ( ) 02 STAINLESS STEEL ( ) 03 FIBERGLASS ( ) 04 POLYVINYL CHLORIDE ( l 05 CONCRETE <br /> ( ) 06 ALUMINUM f 1 07 STEEL CLAD ( 1 08 BRONZE t 1 09 COMPOSITE ( ) 10 NON-METALLIC <br /> (X) 12 UNKNOWN ( ) 13 OTHER: <br /> HSC04-070185 (10/18/85) PAGE 1 <br />